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Clinical Utilization Analyst

2 months ago

Fort Lauderdale, Florida, United States Cleveland Clinic in Florida - Weston Full time
Clinical Utilization Analyst - RN Registered Nurse

The Cleveland Clinic in Florida - Weston is seeking a dedicated Clinical Utilization Analyst to enhance our patient-centered healthcare approach.

As a part of our esteemed healthcare organization, you will collaborate with a team of committed professionals, receiving continuous support and recognition while advancing your career in a respected institution.

Role Overview:
Clinical Utilization Analysts are responsible for executing utilization management tasks, including admission assessments, ongoing reviews, retrospective evaluations, and clinical systems analyses to evaluate clinical performance and address utilization management challenges that impact reimbursement during patient hospitalizations.

Key Responsibilities:
Some of the essential duties of a Clinical Utilization Analyst include:

  • Conducting thorough medical record evaluations.
  • Providing necessary clinical data to insurance providers.
  • Collecting and reporting utilization management data.
  • Managing concurrent denial appeals.
  • Collaborating with clinical teams and Physician Advisors.
  • Engaging in special projects as needed.

Candidates must possess flexible availability to work between 24-40 hours weekly, including evenings and weekends. This role offers the opportunity to work remotely and support in obtaining case management certification. Proximity to a Cleveland Clinic Florida location is required.

Ideal Candidate Qualifications:
The preferred qualifications for the ideal candidate include:

  • Graduation from an accredited nursing program.
  • Current RN licensure in the state.
  • Basic Life Support (BLS) certification from the American Heart Association.
  • Three to five years of full-time clinical nursing experience.
  • Familiarity with medical terminology, anatomy, physiology, and disease processes.
  • Strong analytical skills for data assessment and problem identification.
  • Basic understanding of medical record coding standards.
  • Proficiency in Microsoft Office applications.
  • Knowledge of billing practices and documentation adequacy.
  • Experience with Care Guidelines and Medical Necessity Criteria.
  • Ability to evaluate medical records for determining patient stay length and adherence to policies.

Preferred Qualifications:
Additional qualifications that are preferred include:

  • Bachelor of Science in Nursing (BSN).
  • Case Management Certification (CCM) is advantageous.
  • Experience as a hospital RN along with utilization review or case management experience.
  • Flexibility in scheduling to meet departmental needs.
  • Strong computer proficiency.

Physical Requirements:
Physical demands of the role include:

  • Ability to walk, sit, and stand for extended periods.
  • Attention to detail in reviewing medical records and meeting deadlines.
  • Working in an environment with potential discomfort due to noise and temperature variations.

Personal Protective Equipment:
Adherence to standard precautions and the use of personal protective equipment is mandatory.

We value each candidate and encourage discussions regarding compensation during the application process.